Document Detail


Impact of medication nonadherence on hospitalizations and mortality in heart failure.
MedLine Citation:
PMID:  21807328     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Limited literature exists on the association between medication adherence and outcomes among patients with heart failure.
METHODS AND RESULTS: We conducted a retrospective longitudinal cohort study of 557 patients with heart failure with reduced ejection fraction (HFrEF) (defined by EF <50%) in a large health maintenance organization. We used multivariable Cox proportional hazards models to assess the relationship between adherence (with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, β-blockers, and aldosterone antagonists) and the primary outcome of all-cause mortality plus cardiovascular hospitalizations. Mean follow-up time was 1.1 years. Nonadherence (defined as <80% adherence) was associated with a statistically significant increase in the primary outcome in the cohort overall (hazard ratio 2.07, 95% confidence interval 1.62-2.64; P < .0001). This association remained significant when all 3 classes of heart failure medications and the components of the composite end point were considered separately and when the adherence threshold was varied to 70% or 90%.
CONCLUSIONS: Medication nonadherence was associated with an increased risk of all-cause mortality and cardiovascular hospitalizations in a community heart failure population. Further research is needed to define systems of care that optimize adherence among patients with heart failure.
Authors:
Ashley A Fitzgerald; J David Powers; P Michael Ho; Thomas M Maddox; Pamela N Peterson; Larry A Allen; Frederick A Masoudi; David J Magid; Edward P Havranek
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Publication Detail:
Type:  Journal Article     Date:  2011-06-23
Journal Detail:
Title:  Journal of cardiac failure     Volume:  17     ISSN:  1532-8414     ISO Abbreviation:  J. Card. Fail.     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-08-02     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9442138     Medline TA:  J Card Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  664-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiology, Denver VA Medical Center, Denver, Colorado; Division of Cardiology, University of Colorado Denver School of Medicine, Denver, Colorado.
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